Healthcare Provider Details

I. General information

NPI: 1285033134
Provider Name (Legal Business Name): BRIAN ROSS HOLROYD M.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2014
Last Update Date: 08/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 BUTTERWORTH DRIVE
EDMONTON ALBERTA
T6R 2M7
CA

IV. Provider business mailing address

752 BUTTERWORTH DRIVE
EDMONTON ALBERTA
T6R 2M7
CA

V. Phone/Fax

Practice location:
  • Phone: 780-430-8721
  • Fax:
Mailing address:
  • Phone: 780-430-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG50099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: